Social Worker LCSW - Med/Surg

• Responsible for Psychosocial evaluations -- identification of problems affecting optimal patient care and the development of a treatment plan.
• Responsible for crisis intervention and individual and family counseling.
• Interdisciplinary discussion of psychosocial implications of illness including consultation regarding treatments and resources designed to solve the problems of the patients.
• Evaluates and implements social service programs for patients with psycho/social issues focusing on seniors, catastrophic and chronically ill patients.
• Performs triage for patients within corresponding team(s) and assists in coordinating patient care delivery, including DPA/POSLT and documents pertinent information in the case management system.
• Implements transitions of care between inpatient and continued outpatient follow up and vice versa.
• Initiates and/or participates in team care conference to include patient, family and care providers.
• Evaluates daily caseload and assess achievement of long and short term goals; Modifies goals with providers and care team based upon patient outcomes.
• Compiles and presents statistics and reports relating to patient outcomes and document findings in the patients EMR.
• Follows up on communication to the referral source, IE, PCP, family member, case manager, home health personnel, community social worker, Health Plan, etc.
• Acts as the social services liaison for the department, particularly in the areas of: Advance Care Planning discussions, Complex discharge planning, Biopsychosocial assessments.
• Refers patients to agencies that provides supportive services optimizing patients health plan benefits. Provides alternatives for patients requiring specific services.
• Assists in arranging community resources (i.e. meals on wheels, transportation services, adult day care, and info-line) and in the long term planning for patients transitioning to institutional setting.
• Participates in advance care planning initiatives.

• Master?s degree in Social Work from an accredited college.

• 3 years' experience in an acute care hospital setting
• 2 years clinical social work experience including palliative or hospice care, and discharge planning, with experience in project management/process improvement is preferred

• Licensed Clinical Social Worker (LCSW) - California license is required.

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